What are the most common erectile dysfunction drugs?

The most common erectile dysfunction drugs, based on U.S. and worldwide sales data, are the PDE5 inhibitors, all of which work by temporarily blocking the effects of an enzyme known as phosphodiesterase-5. The PDE5 enzyme can impede blood flow to the penis and make it more difficult — or even impossible — to achieve and maintain an erection hard enough for intercourse.

Among the PDE5 inhibitors, the best-selling drug in the United States during 2013 was Viagra, which had sales of nearly $1.2 billion. Viagra (sildenafil citrate) was only slightly ahead of Cialis (vardenafil), which had 2013 sales of $1.09 billion in the United States. Two different formulations of Cialis are available in the United States: Cialis for Daily Use and Cialis for Use as Needed. The latter is effective for up to 36 hours.

While Viagra and Cialis had the lion’s share of the ED market in 2013, other impotence drugs available included Levitra and Staxyn (both tadalafil) and Stendra (avanafil).

Viagra for women: Does it exist?

Thus far the FDA has not approved a prescription drug specifically designed to fire up women’s sexual desire. According to ABCNews.com, a study in the early 2000s showed that postmenopausal and post-hysterectomy women taking 50-milligram Viagra pills reported “better overall sexual satisfaction” than those who got a placebo.

Meanwhile, Sprout Pharmaceuticals, the manufacturer of a drug called flibanserin, is continuing to press its application to have the FDA approve the drug for marketing as a treatment for HSDD (hypoactive sexual desire disorder), the most common form of female sexual dysfunction. Although the federal drug agency gave flibanserin a thumbs-down in late 2013, it did offer Sprout fairly clear-cut guidance about what additional testing would be necessary to keep the application alive. That testing is currently underway, and a revised application is expected to be filed in the third quarter of 2014.

Vacuum pumps vs. Viagra: Any opinions?

Although most men prefer oral ED medication, including not only Viagra but also Cialis, Levitra, Staxyn, and Stendra, these drugs are incompatible with nitrate-based drugs, making the vacuum pump an alternative ED treatment for men who are taking those drugs for angina.

Also known as a vacuum constrictive device, the vacuum pump also offers an alternative for men who find the side effects of Viagra uncomfortable or troublesome. While these side effects are usually mild and disappear after continuing use of the drug, each individual reacts differently, and some men may prefer avoiding the medication altogether.

That said, the vacuum pump has its own drawbacks, perhaps the most notable of which is the time — 10 to 20 minutes — it takes to achieve an erection strong enough for intercourse. Coupled with the cumbersome mechanical nature of the device and the potential for bruising and penile pain, these disadvantages may make use of the pumps undesirable for many.

Trying to figure out if I have premature ejaculation: How long is normal?

If you’re consistently unable to delay ejaculation for more than a minute after beginning intercourse, you probably are suffering from premature ejaculation, according to MayoClinic.com. In other words, there’s no need to panic if this has happened to you as an isolated incident, but if it’s a regular thing you should probably take your concerns to your doctor.

The average time from the beginning of intercourse to ejaculation is five minutes, says Mayo Clinic. But if you feel you have no control over the ejaculation process or if ejaculation occurs earlier than you’d like, talk to your doctor. Although it’s not always easy to discuss sensitive sexual matters with your doctor, you’ll need to man up in order for the two of you to find a way in which to treat the problem.

Techniques to prolong erection?

In a Sexploration column for NBCNews.com, writer Brian Alexander offers a couple of suggestions on ways to prolong an erection and the pleasure of your partner. Actually, the first one comes from sex therapists Masters and Johnson and requires the participation of your partner. Just as you are about to climax, have your partner squeeze the tip of the penis with the thumb, index finger, and middle finger. Alternatively, the base of the penile shaft can be squeezed. You’ll experience the sensation of orgasm but will not ejaculate and will be able to recover your erection quickly so that you can continue.

The second technique involves a muscle known as the pubococcygeus. It’s the one you can use to slow or stop your urine flow, and it’s the same muscle that some men use to make their penis bounce up and down as a form of self-amusement. With regular workouts of this muscle, you can get to the point where you can experience multiple orgasms. Begin by draping a towel or washcloth over your penis and then use the pubococcygeus muscle to move your penis up and down with that extra weight on it. If you start with only a washcloth, switch to a wet washcloth when lifting the washcloth alone becomes too easy. Alexander recommends doing this exercise at least 100 times daily.

Penis enlargement pills: Do they work?

In a word, no. In an article for AskMen.com, writer Luke Young puts it somewhat more colorfully, saying a penis enlargement pill “has about as much chance of increasing the size of your manhood as NBC does of ever getting Conan O’Brien to return to its network.”

In its overview of all the many penis-enlargement products on the market, MayoClinic.com says these pills “usually contain vitamins, minerals, herbs, or hormones that manufacturers claim enlarge the penis. None of these products has been proved to work, and some may be harmful.”

Lest you still be holding out hope that these pills might work for you, Dr. Michael O’Leary gave Medicinenet.com his views on penis-enlargement promises: “It’s pretty much bunk.” O’Leary is a urologist at Harvard Medical School and Brigham and Women’s Hospital in Boston.

My doctor ordered a nocturnal tumescence test: What is it?

Designed to indicate whether your physical equipment is in good working order, a nocturnal tumescence test tells the doctor whether you’ve had an erection during sleep. Normal, healthy men have three to five nocturnal erections nightly, most of which occur during REM (rapid eye movement) sleep.

If the test indicates you are having nighttime erections, it signals to your doctor that any erectile problems you may be having are likely to be psychological in origin rather than physiological.

The test can be done at home or in a special sleep laboratory, according to WebMD.

In the most simple form of this test, a snap gauge consisting of plastic film is fitted around your penis. The gauge is designed to break when subjected to certain pressures, specifically the pressure caused by an erection.

In a lab setting, your penis can be fitted with an electronic monitoring device that records the number and strength of erections that occur during the night.

Kegel exercises for erectile dysfunction: Do they work?

Kegel exercises, also known as pelvic floor exercises, are designed to strengthen the muscles that control your bladder, according to WebMD. Although their primary goal is to control urinary leakage, these exercises have a couple of added benefits for men: They can improve the strength of your erection and help you to experience more intense orgasms.

You first must locate the muscles that these exercises target. You may be able to do this during urination. Midway through urination, try to slow down or stop altogether your urine flow without holding your breath or tensing the muscles in your buttocks, legs, or abdomen. When you are able to stop or slow urine flow, you’ve zeroed in on the right set of muscles. Then:

“Contract these muscles for a slow count of five.

“Release these muscles to a slow count of five.

“Repeat 10 times.

“Do a set of 10 Kegels daily, three times a day.”

Is Viagra covered by insurance?

Health insurance plans that include prescription drug coverage may or may not cover Viagra and other impotence drugs. Checking out the insurer’s prescription drug formulary will allow you to see which brand-name drugs are included under the plan’s coverage. Typically, the formulary has three tiers, although individual plans may have other names for them. Tier I drugs are generics and have the lowest copays of all, while Tier II drugs are the insurer’s preferred brand-name drugs and have somewhat higher copays than Tier I drugs. Tier III drugs are non-preferred brand-name medications that are available only with a hefty copayment.

Because health plans available under Obamacare are also sold by individual insurers, you’ll need to check out each insurer’s drug formulary to determine what drugs are covered and at what level of copay. Medicare does not cover drugs for the treatment of sexual or erectile dysfunction.

Is there surgery for premature ejaculation?

Premature ejaculation is the most widespread form of sexual dysfunction, affecting roughly 20 percent of all men between the ages of 18 and 59, according to the Urology Care Foundation. The primary modes of treatment for PE are low-dose antidepressants and anesthetic creams that are topically applied to the head of the penis 20 to 30 minutes before sexual activity.

Although there is no widely used surgical procedure for treating PE, two Iranian researchers reported on an experimental form of surgery that was helpful to circumcised men who still had remnants of their foreskin present. Under local anesthesia, 47 men had these foreskin remnants surgically removed. Asked to report on post surgical changes in their sex lives, 95.7 percent of the men said they had better control over ejaculation. Time to ejaculation from the beginning of intercourse went from an average of 64.25 seconds before surgery to 731.49 seconds after the procedure, according to the study, which was published in the May-August 2011 issue of “Urology Annals.”